Images of Memorable Cases: Case 66 This 55-year-old man presented with a three-week history of diffusely swollen gums that had made eating difficult. On examination, he also had shotty generalized lymphadenopathy, a palpable spleen, and ecchymoses over both legs. 66. Acute myelomonocytic leukemia This patient’s total leukocyte count was 96.2 x 10,000 mm 3 size 12{ ital "mm" rSup { size 8{3} } } {} with 12% lymphocytes, 38% monocytes, and 50% blasts. His bone marrow study confirmed the diagnosis. Major infiltration of the gums by leukemic cells is common in acute myelomonocytic or monocytic leukemia and may be the presenting manifestation. This feature is less frequent in other types of acute leukemia. Noticeable gingival hypertrophy may also result from several drugs (phenytoin, cyclosporine, nifedipine, diltiazem, verapamil and penicillamine), and from various maladies (scurvy, sarcoidosis, Crohn’s disease, amyloidosis, lymphoma, Kaposi’s sarcoma, cytomegalovirus infection, Wegener’s granulomatosis, and hereditary gingival fibromatosis).